Sensory Integration or Sensory Processing?

People often use the terms ‘Sensory Integration’ and ‘Sensory Processing’ to refer to the same theory. The theory was initially identified by A Jean Ayres in 1972. She referred to it as ‘Sensory Integration. The term ‘Sensory Integration’ was first used in 2006, by Lucy Miller, whose work was based on Ayres’.

Nowadays, authors typically use either one term or the other, depending on their training and work experience. Therapists often use the term that they were taught when they trained, which is influenced by who they trained with, and where and when they trained.

To clarify ‘Sensory Integration’ and ‘Sensory Processing’ mean the same thing. Here’s a more detailed account of Ayres’ and Miller’s work:

Sensory Integration

A Jeans Ayres in 1972 (p.1) first described Sensory Integration (SI) as ‘the organisation of the senses for use.’ Ayres was a psychologist and occupational therapist working with children with learning disabilities in California. Noticing that many of these children interpreted sensory information differently to their peers, she focussed a lot of her attention on the touch, vestibular, proprioceptive and vision senses. Her research indicated that the children she was working with did not integrate the messages from these senses very well. As a result, she theorised children could have poor posture, poor coordination of both sides of the body, sensory sensitivity, poor discrimination and/or dyspraxia.

Ayres felt that the sensory integration dysfunction was contributing to the children’s difficulties with learning. She found that if she treated the children using a SI approach they made improvements in their learning. Many therapists still use this treatment approach today (Ayres SI®).

Image: Western Psychological Services SI and the Child 1979

Sensory Processing Disorder

Lucy Miller first used the term Sensory Processing Disorder (SPD) in 2006 to describe sensory issues in her book, Sensational Kids. Miller had initially studied under Jean Ayres. She has since continued to research sensory integration along with colleagues. The primary aim of this collaborative research was to have Sensory Processing Disorder identified as a stand-alone diagnosis by the American Psychology Association in their updated manual the DSM-5. Miller defined three parts to Sensory Processing Disorder: modulation; discrimination and sensory-based motor disorders.

Miller’s model draws heavily on Ayres’ initial work and theory. I feel that the format is easier for parents and teachers to follow.

Miller has also published her treatment model (A SECRET, Bialer & Miller 2012).

Image: Lucy Miller, Sensational Kids; Hope and Help for Children with Sensory Processing Disorder (2006)

At their core, both models refer to the same primary idea, they just use different terminology. Where Ayres refers to ‘Sensory Integration Dysfunction’, Miller and colleagues use ‘Sensory Processing Disorder’. Ayres used the term ‘tactile defensiveness’ to describe what Miller calls ‘sensory modulation, tactile over-responsivity’. Ayres described ‘postural ocular and vestibular ocular disorders’, but Miller uses the term ‘Sensory Based Movement – Postural Disorders’. Both authors use the terms ‘dyspraxia’ and ‘sensory discrimination’. Ayres included ‘bilateral integration’ and ‘sequencing’ and Miller has not.

Is there a difference in how therapists from each tradition approach treatment?

In short, yes.

A pure Ayres SI® approach will be led by a trained therapist in a specialised clinic space. It must be child-led. The therapist will continually create opportunities at a ‘just right’ level to help improve the child’s sensory integration. Therapists using Ayres SI® should be following the fidelity measure outlined by Parham and colleagues in 2011. Miller’s model uses this approach, however, it includes additional therapies such as listening therapy. It also includes greater parent involvement in therapy and extra strategies for home and school. Most other authors will outline sensory strategies that can help to support the senses at home and school. These strategies can be used to complement direct sensory integration treatment.

In short, the terms ‘sensory integration’ and ‘sensory processing’ refer to the same main theory and idea. For many ideas, once the founder has passed on their knowledge, different roads are taken by their students. This has been the case for sensory integration theory, which has led to the use of the term ‘sensory processing’. Hopefully, these different roads will ultimately lead to strong evidence, outcomes and supports for the children and adults that need help to organise their senses.

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